Chp 46- vulvar and vaginal disease and neoplasia Flashcards
The major symptoms of vulvar disease are _____.
pruritus, burning, nonspecific irritationn and/or appearnce of a mass.
How does lichen sclerosus look?
diffuse involvement of vulva with very thin, whitish epithelial areas (onion-skin), cigarrette paper skin, parchement like, may extend to a perianal halo, severe cases can cause obliteration of labial and periclitoral folds with vaginal stenosis
Etiology of lichen sclerosus
unknown, familial association, association with immune disorders
Histologic appearance of lichen sclerosus
lichenoid- band like lymphocytic infiltrate of upper dermia and epidermal basal layer damage. Dermal homogenization due to cell death, flattened rete pegs (pathognomonic). 1/3 have acanthosis/hyperkeratosis
Treatment of lichen sclerosus
Pt w/ large acanthotic component- well penetrating corticosteroid cream (improvement in 2-3 weeks). Topical steroid preparations like clobetasol. Intermittent treatment may be needed indefinitely.
Risks of lichen sclerosus
Increased SCC risk (4%). Condition needs to be monitored with repeat biopsies
How does lichen simplex chronicus look?
diffusely reddened areas with occasional hyperplastic or hyperpigmented plaques of red to reddish brown, may have areas of linear hyperplasia
Etiology of lichen simplex chronicus
an itch that rashes (progressive vulvar pruritus), often second to irritant dermatitis,
Histologic appearance of lichen simplex
epidermal thickening/hyperplasia and inflammatory cell infiltrates. Biopsy usually not warranted.
Tx of lichen simplex chronicus
dephenhydramine or hydroxyzine with topical steroid cream. use triamcinolone acetonide or betamethasone if there are significant areas of hyperkeratosis.
When is biopsy of lichen simplex chronicus warranted?
When there is no significant relief within 3 months
What is lichen planus?
rare inflammatory skin condition that can be generalized or isolated to the vulve and vagina
What does lichen planus look like?
desquamative lesion of vagina, may have lesions on vulva near inner aspects of labia minora and vestibule. May have white lacy bands (wickham striae) or keratosis near reddish ulcerated lesions.
How does someone with lichen planus present?
chronic vulvar burning and/or pruritus, insertional dyspareunia, profuse vaginal discharge
What does biopsy of lichen planus look like?
no atypia, large numbers of acute inflammatory cells, thinned epithelium, loww of rete ridges, basal cell liquefactive necrosis
treatment of lichen planus
topical steroid preparations, intravaginal 1% hydrocortisone douches
What is psoriasis?
an AD inherited disorder that can involve the vulvar skin as part of a generalized dermatologic process
How does psoriasis look?
silver scale appearance 1x1 to 1x2 cm
What is Auspitz sign?
punctate bleeding if silvery psoriatic lesions removed
Histologic pattern of psoriasis
acanthotic pattern with distinct dermal papillae that are clubbed and chronic inflammatory cells between them
Psoriasis treatment
topical coal tar preparations with UB light and cs medications. Topical cs are best
What are the types of vulvar dermatitis?
Eczema: exogenous (irritant, allergic contact), endogenous (atopic). Spongiotic pattern histo.
Seborrheic dermatitis: pale red to yellow pink and may look oily
Treatment for vulvar dermatitis?
perineal hygiene and use of 5% Al acetate several times a day
